Raloxifene and cardiovascular health: its relationship to lipid and glucose metabolism, hemostatic and inflammation factors and cardiovascular function in postmenopausal women

Abstract

CHD is one of the most common serious chronic conditions in postmenopausal women and leads to extremely high risk for recurrent myocardial infarction and death. On the basis of the currently available randomized clinical-trial results the role of conventional HRT for treatment and prevention of CHD is rapidly evolving from presumed benefit to proven harm, at least in some categories of women yet to define. For this reason there has been a particular interest in potential clinical uses of selective estrogen receptor modulators (SERMs). SERMs are a class of compounds that can act as estrogen receptor (ER) agonists in some domains (bone and lipids) and acting as ER antagonists in others (breast and uterus). Raloxifene hydrochloride is an antiestrogen that is currently approved only to treat osteoporosis in postmenopausal women. Because of its effects on lipids and other biomarkers of cardiovascular risk, there is great interest in determining whether it may benefit the cardiovascular system. The great majority of data on cardiovascular effects of raloxifene concern effects on lipids and markers of thrombosis and inflammation. The purpose of this review is to summarize the best available evidence concerning raloxifene and cardiovascular disease focusing some areas known to be important risk factors for cardiovascular diseases: lipids and lipoproteins, glucose metabolism, hemostatic factors, markers of inflammation and cardiovascular function.